URAC, a health care accreditation organization, announced earlier this week that it is making progress developing quality metrics designed for PPO (preferred provider network) plans. URAC first announced these development efforts in September 2006 and based on public comments it has prepared the metrics for beta testing.
URAC explains that
It has put forward three principles for the measures:
* Performance measures should address dimensions of health plan performance that the consumer values—specifically those that concern consumer choice;
* Performance measures should target results that health plans or care management vendors are accountable for and have the ability to influence;
* Performance measures should be based on data that can be collected and reported in a consistent fashion across the continuum of health benefit plans.
The metrics themselves will fall under three broad categories:
* Service Quality
* Consumer Protection & Empowerment / Navigation
* Satisfaction with Service
Sample measures may include tracking client or consumer satisfaction rates, complaint rates, provision of care coordination and consumer navigation tools, provision of price and quality transparency and provision of quality incentives.
These URAC metrics likely will be a useful alternative to the NCQA’s HEDIS metrics which are HMO plan oriented.